Ethics and rural healthcare: what really happens? What might help?

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.     

Buffered forgetting: When targets and distractors are both forgotten

In three experiments, we investigated prior findings that, following some memory tasks, essentially flat d' or forced-choice retention curves are produced. These curves have been interpreted as indicating that forgetting is not present over the intervals examined; however, we propose in this article that forgetting is actually present whenever hit rates and false alarm rates are both declining, despite the result being a flat retention curve. We demonstrate that such curves can be produced using a pair recognition procedure, a plurality discrimination task, and a verbal discrimination task. For all of these tasks, we provide either new evidence or refer to evidence already in the literature that tends to contradict alternative explanations. Then we show how the failure to consider both signal strength and noise has led to distortions in theoretical thinking about forgetting.     

The Use of Homework in Cognitive Behavior Therapy: Working with Complex Anxiety and Insomnia

Homework, or self-help, is an essential and required part of cognitive behavioral treatment. It offers several opportunities for the therapist to extend and increase therapy contact by having the patient “live” the therapy outside of the consulting room. It can also serve as a measure of the patient’s motivation for therapy or for change. Homework offers the patient an opportunity to practice what has been developed and discussed in the therapy session. By trying out new behaviors, new ideas, or new emotional responses, the patient can make “real” what has been an abstraction in the therapeutic dialogue. The homework becomes an opportunity for gathering data. Inasmuch as the homework grows “organically” from the session content, it is relevant and timely. Homework provides continuity between sessions. Rather than sessions being discrete moments in time, they are chained together by the homework from the previous session being included in the agenda for the subsequent session. The homework can be structured to involve significant others. This is essential in many therapeutic situations, and having the significant others involved can substantially aid in relapse prevention. Finally, effective homework helps to build therapeutic collaboration and afford the patient the opportunity for building self-efficacy. Using several case examples, this paper describes the functions and impediments to using homework in CBT.     

Report of the ACA Ethics Committee: 2004–2005

This report summarizes the activities of the American Counseling Association (ACA) Ethics Committee during the period of July 1, 2004, through June 30, 2005. Summary data of the complaints filed and the inquiries received are presented.